Bottom Line:
However, few studies have evaluated the effect of treatment interventions on biomarker expression.Furthermore, the changes to insulin-like growth factor 1 (IGF-1) levels might indicate a beneficial role for fatigue in obese FM patients.Additional RCTs focused on the changes to inflammatory biomarker expression after non-pharmacological interventions in FM patients are needed.

Introduction: Fibromyalgia (FM) is a prevalent disorder. However, few studies have evaluated the effect of treatment interventions on biomarker expression. The aim of this review was to explore the efficacy of non-pharmacological interventions on inflammatory biomarker expression, specifically cytokines, neuropeptides and C-reactive protein (CRP), in FM patients.

Method: A literature search using PubMed, EMBASE, PsycINFO and the Cochrane library was performed from January 1990 to March 2015. Randomized controlled trials (RCTs) and non-RCTs published in English, French or Spanish were eligible.

Results: Twelve articles with a total of 536 participants were included. After exercise, multidisciplinary, or dietary interventions in FM patients, interleukin (IL) expression appeared reduced, specifically serum IL-8 and IL-6 (spontaneous, lipopolysaccharide (LPS)-induced, or serum). Furthermore, the changes to insulin-like growth factor 1 (IGF-1) levels might indicate a beneficial role for fatigue in obese FM patients. In contrast, evidence of changes in neuropeptide and CRP levels seemed inconsistent.

Fig2: Risk-of-bias graph: reviews the authors’ judgments about each risk-of-bias item presented as percentages across all of the included studies

Mentions:
Of all of the included articles, two studies [26, 27] were conducted with almost the same population. With regard to interventions, three types were assessed: complementary and alternative medicine (CAM) (e.g., balneotherapy, massage, mud bath, guided imagery, dance/movement therapy, and dietary therapy), exercise, and multidisciplinary therapy. All of the FM patients were diagnosed by the 1990 ACR criteria [16] (Ortega et al. [28] did not declare the year of the ACR criteria), and the mean age of the participants ranged from 43.4 to 57.0 years old (Ortega et al. [28, 29] did not declare age). With respect to study design, we included eight RCTs, and the remaining four articles included were non-RCTs. According to the Cochrane risk-of-bias tool [25], two studies [30, 31] were considered high quality, but the other trials were low quality with a high risk of bias (Figs. 2 and 3). In addition, of our included trials, only four trials [26, 27, 32, 33] were performed under active control conditions, although two trials [26, 27] were almost the same population. None of these studies included evidence about how the participants rated both the primary and active control conditions as credible, and the likelihood of producing positive results due to baseline intervention expectations was not evaluated. Meanwhile, in relation to the baseline values of each biomarker, our findings revealed that the baseline levels of IL-8 and CRP in FM patients are significantly increased when compared to the healthy control group [28, 34].Fig. 2

Fig2: Risk-of-bias graph: reviews the authors’ judgments about each risk-of-bias item presented as percentages across all of the included studies

Mentions:
Of all of the included articles, two studies [26, 27] were conducted with almost the same population. With regard to interventions, three types were assessed: complementary and alternative medicine (CAM) (e.g., balneotherapy, massage, mud bath, guided imagery, dance/movement therapy, and dietary therapy), exercise, and multidisciplinary therapy. All of the FM patients were diagnosed by the 1990 ACR criteria [16] (Ortega et al. [28] did not declare the year of the ACR criteria), and the mean age of the participants ranged from 43.4 to 57.0 years old (Ortega et al. [28, 29] did not declare age). With respect to study design, we included eight RCTs, and the remaining four articles included were non-RCTs. According to the Cochrane risk-of-bias tool [25], two studies [30, 31] were considered high quality, but the other trials were low quality with a high risk of bias (Figs. 2 and 3). In addition, of our included trials, only four trials [26, 27, 32, 33] were performed under active control conditions, although two trials [26, 27] were almost the same population. None of these studies included evidence about how the participants rated both the primary and active control conditions as credible, and the likelihood of producing positive results due to baseline intervention expectations was not evaluated. Meanwhile, in relation to the baseline values of each biomarker, our findings revealed that the baseline levels of IL-8 and CRP in FM patients are significantly increased when compared to the healthy control group [28, 34].Fig. 2

Bottom Line:
However, few studies have evaluated the effect of treatment interventions on biomarker expression.Furthermore, the changes to insulin-like growth factor 1 (IGF-1) levels might indicate a beneficial role for fatigue in obese FM patients.Additional RCTs focused on the changes to inflammatory biomarker expression after non-pharmacological interventions in FM patients are needed.

Introduction: Fibromyalgia (FM) is a prevalent disorder. However, few studies have evaluated the effect of treatment interventions on biomarker expression. The aim of this review was to explore the efficacy of non-pharmacological interventions on inflammatory biomarker expression, specifically cytokines, neuropeptides and C-reactive protein (CRP), in FM patients.

Method: A literature search using PubMed, EMBASE, PsycINFO and the Cochrane library was performed from January 1990 to March 2015. Randomized controlled trials (RCTs) and non-RCTs published in English, French or Spanish were eligible.

Results: Twelve articles with a total of 536 participants were included. After exercise, multidisciplinary, or dietary interventions in FM patients, interleukin (IL) expression appeared reduced, specifically serum IL-8 and IL-6 (spontaneous, lipopolysaccharide (LPS)-induced, or serum). Furthermore, the changes to insulin-like growth factor 1 (IGF-1) levels might indicate a beneficial role for fatigue in obese FM patients. In contrast, evidence of changes in neuropeptide and CRP levels seemed inconsistent.